Reducing the Stigma of HIV/AIDS in Uganda

In previous blogs, What is Stigma? and Stigma and Disability: Stereotypes we have seen the roles of stigma and negative stereotypes in stigmatizing disability. This blog will look at one way of reducing stigma for those with the human immunodeficiency virus/autoimmune deficiency syndrome (HIV/AIDS). This blog asks how can stigma and negative stereotypes associated with HIV/AIDS be reduced? Uganda 2015 figures from the HIV AND AIDS IN UGANDA report says there are:

• 1.5 million people that are HIV positive.
• 7.1% adult prevalence of HIV.
• 83,000 new infections.
• 28,000 AIDS related deaths.
• 57% of adults are on anti retro-viral therapy (ART).

Stigma associated with HIV/AIDS is very high. Approximately half the males and females with HIV/AIDS would prefer to keep their HIV status a secret from their family says a 2005 survey by the Uganda Ministry of Health (see Examining the actions of faith-based organizations and their influence on HIV/AIDS-related stigma: A case study of Uganda). Without doubt the stigma of HIV/AIDS is one of the biggest hindrances to the successful treatment of people with HIV/AIDS. The report HIV AND AIDS IN UGANDA describes the stigma associated with HIV/AIDS:

Prejudices and social discrimination are some of the leading causes for certain groups of Uganda’s population, such as sex workers and men who have sex with men, to avoid seeking health care or HIV testing. However, even the general population of people living with HIV are subjected to excessive amounts of negative judgement.
The People Living with HIV Stigma Index 2013 reported experiences of both external and internal stigma. The index states that the most common forms of external stigma and discrimination directed at people living with HIV are gossip at 60%, followed by verbal harassment, insults and or threats at 37%, and sexual rejection at 21.5%.
Outlining the common forms of internal stigma experienced by both men and women living with HIV, the index cites low self-esteem at 67%; self-blame at 50%; shame at 50%; guilt at 50%; and blaming others at 50%.
On the whole, experiences of all forms of internal stigma were higher among females compared to their male counterparts. The prevalence of adult women aged 15-49 who reported being subjected to some form of discriminatory attitude stood at 80.3% in 2011.

The 2013 report, Harnessing Poverty Alleviation to Reduce the Stigma of HIV in Sub-Saharan Africa, looks at an intervention to reduce 3 stigmas related to HIV/AIDS. It begins by identifying the the role of stigma in in HIV infection.

Relationships between HIV, disability, and stigma.

HIV infection has adverse health and economic impacts, undermining HIV-infected persons' abilities to maintain their full economic contributions to family and community life and engage in reciprocal exchange. Stigmatization and exclusion from local solidarity networks erodes their food and livelihood security, which in turn undermine their adherence to ART (anti retro-viral therapy). Non-adherence to ART perpetuates this cycle by further compromising health and economic viability.

By offering ART together with livelihood education, it is hoped that some of the stigma of HIV/AIDS will be reduced. The approach works in the following way:

Transforming HIV-stigmatizing beliefs through ART-plus.

ART manages the disability incurred through HIV infection, undermining the view of HIV-infected persons as economically inadequate members of the community and permitting them to re-engage in productive activity. Livelihood interventions, such as combined financial literacy and microenterprise management programs, may additionally create new modes of engaging in productive activity, such as new trades or new enterprise development. These financial contributions are welcomed within local solidarity networks, and the norm of reciprocity is upheld.

Stigma is a complex issue. This is one way of many ways of reducing stigma. he simplicity of this model provides a clear understanding of  the role of stigma in preventing ART. It is hoped that this strategy of combining ART with financial education will empower those with HIV and remove some of the stigma associated with HIV/AIDS. This in turn will reduce some of the disabling aspects of HIV/AIDS discrimination.